The flat fee you pay at the time of service — here's how it works.
A copay (short for copayment) is a fixed dollar amount you pay at the time of a healthcare service — like a flat fee for access to care. It's one of the simplest cost-sharing structures in health insurance.
You go to the doctor. The visit might cost $200. But your plan has a $30 primary care copay. You pay $30 at the front desk. Insurance handles the rest (after applying any applicable discounts). You don't have to calculate percentages or wait for a bill.
Sometimes, sometimes not — this varies by plan. Many plans apply copays even before you meet your deductible. Check your Summary of Benefits to understand the order of operations on your specific plan.
Every copay you pay counts toward your annual out-of-pocket maximum (on most plans). So even those $30 visits add up and bring you closer to your annual cap.
High-deductible health plans (HDHPs) often don't have copays for office visits — you pay full cost until you meet your deductible. The tradeoff is a lower premium. Know which structure your plan uses before assuming you'll pay a small copay.